HEALTHCARE CREDENTIALING SPECIALIST

About the Role

We are seeking a Healthcare Credentialing Specialist with strong experience in managing provider enrollment, credentialing, and compliance with regulatory guidelines. The ideal candidate will have a keen eye for detail, excellent communication skills, and the ability to work collaboratively with providers, payers, and internal teams.

Key Responsibilities

• Manage the full-cycle credentialing and re-credentialing process for healthcare providers.

• Verify and maintain provider documentation, licenses, certifications, and affiliations.

• Coordinate with insurance companies, hospitals, and healthcare organizations for provider enrollment.

• Ensure compliance with NCQA, CMS, and other regulatory requirements.

• Maintain accurate and up-to-date records in credentialing databases.

• Communicate effectively with providers regarding application status, missing information, or required updates.

• Support audits, reporting, and quality improvement initiatives.

Qualifications

• Minimum 1 year of hands-on experience in healthcare credentialing or provider 

• Familiarity with credentialing software/systems (CAQH, NPPES, PECOS, etc.).

• Excellent organizational and documentation skills.